5 things CFOs need to communicate to CIOs to prevent overspending

The current healthcare landscape is calling for more collaboration, and possibly the most important partnership is that of the CIO and CFO. With new IT becoming a pressing necessity, it's crucial both professionals understand the ins and outs of IT spending.

"In terms of working with hospitals on their IT spend, it's a new thing," said Jeff Muscarella, EVP of IT at spend management consultancy company NPI. "When we started the company 10 years ago, many folks didn't know you could go out and look for a Kelley Blue Book of IT products and service and pricing. Nowadays, it's become more common."

"We speak to CIOs a lot, and some of the challenges they face aren't just pricing; they're more holistic, and we help them think about it in a holistic fashion."

To help CFOs and CIOs take a universal look at the cost of their IT, Muscarella outlines five things CFOs need to communicate to CIOs to prevent overspending.

1. Gain internal alignment. The number one thing CFOs should communicate to CIOs, said Muscarella, is the importance of gaining internal alignment. "And what we mean by that is some of the blocking and tackling - having good budgeting processes in place and good relationships with their internal clients or users, like doctors and nurses who need services from IT." Healthcare organizations have become better at getting everyone on the same page, said Muscarella, but understanding departmental needs will help to create a true budget forecast cycle, "so you have some visibility into what those needs are and what they may cost," he said. Failing to maintain internal alignment, he warned, makes it easy for vendors to approach specific departments and throw off an organization's budget year. "[They approach] hospitals or physician groups and get them wanting solutions that may be overlapping with something the IT department already has on its strategic plan," he said. "It lands on their doorstep six months into their budget year, and it may only be half a million, but it begins to throw things out of whack."

2. Benchmark your spending. It's becoming much more common place to benchmark spending, said Muscarella. "I spoke with a CIO yesterday who was doing it, and they were benchmarking everything from internal salaries to how much they pay for certain things," he said. "[This helps] companies drive more savings, even more than they realize, because they're paying too much." To clarify, Muscarella said IT pricing is one of the most complicated markets out there, since there isn't a public list price available for products and services. "The technology itself changes so quickly, that you're not buying the same product [that it was] three years ago," he said. "The pricing models for them changes." Historically, Muscarella added, CIOs talk to their peers to formulate a good price for IT solutions. "They say, 'I'm thinking of buying this product and at 50 percent off, it's pretty good,' but, in reality, 80 percent may be the real spot," he said. "So reaching out to know what's common in the market place for pricing and terms and conditions - what are the key contract terms, especially as it relates to cloud offerings, since you don't own the underlying software."

3. Don't get stuck in 'vendor lock.' Once the big-name vendors make their way into your organization, it makes sense to stick with the products they offer in their umbrella. But, Muscarella said it's important to go through a "sourcing process" and invite in other potential solution providers to keep it competitive. "Too often, people get locked into one vendor strategy, and they forget to do that," he said. "There isn't a whole lot of pressure on that incumbent vendor to keep things tight and focused." Explore your options, he said, and don't forget to "beware of the bundle." Large vendors, he said, "love to bundle…they bundle things together, and sometimes, a bundle could make sense, but unfortunately, 75 percent of the time or more, a bundle contains more than you need." A basic example Muscarella and his team uses is Microsoft Word or Excel. "How many features do you actually use?" he said. "There's hundreds of thousands, but for most of us, we only use 10 percent of them."

4. Question your maintenance charges. Muscarella and his team have begun asking people to "push back" and question their operating costs and maintenance charges. "They tend to go up 3 or 4 percent every year and no one asks questions," he said. "But in this environment, we had success helping CIOs go in and trim their maintenance budgets." One of the more common ways to question charges is to ask yourself what you actually still need maintenance on. Sometimes, said Muscarella, a system is old and works fine, "and you don't need the platinum level support; 8 to 5 is fine because you aren't changing it." Other cases include simply going back and telling a vendor you aren't comfortable with certain charges. "If you think about it, maintenance is 18 to 20 percent of the purchase price, and then it goes up 3 or 4 percent each year," he said. "It doesn't take long, about five years, until you've rebought that entire product. That's an important thing to bring to the attention of your vendors."

5. Stay on top of going rates for outside services. With more organizations using outside services and paying contractor rates, said Muscarella, it's important to benchmark and stay on top of going rates for outside professional services. "Or, a lot of times, they end up going with these fixed fee engagements," he said. "On the surface, that's great because you don't worry about overages, but in reality, there's a lot of language in those agreements that leaves room for overages." For example, he said, a vendor can come back and make a case by pointing out "assumptions" the organization said it was going to do, or not having data set up the way it claimed it would. "Then they say, 'Well now we have to do a change order,'" he said. "So the fixed fee engagements that aren't defined well or don't have adequate protections frequently result in change orders." And, before you know it, you're back to the pay-as-you-go model. Muscarella advised that folks go ahead and "bid it on a time of materials" basis, since this will lend insight into what the vendor is thinking about the project. "If you see what kinds of people they're assigning and their skill levels, hourly rates, and how much time, you can look at that and say, 'that makes sense," or 'they're underestimating the amount of work here,'" he said. "If you do fixed fee, you don't see that detail and you're more in the dark and hoping they got it right."

Nurses Key In Helping New Cancer Patients Overcome Fears

Often faced with overwhelming anxiety, patients newly diagnosed with lung cancer can find themselves in distress, and new research recommends nurses play a key role in alleviating concerns, leading to a better quality of life for patients.

A diagnosis of lung cancer - the leading cause of cancer death in the United States - brings with it high levels of stress and raises existential issues and death-related thoughts and concerns in patients, said Rebecca H. Lehto, assistant professor in the College of Nursing at Michigan State University.

In a paper published in the current edition of the Clinical Journal of Oncology Nursing, Lehto lays out several ways nurses can help bridge the gap between diagnosis and a strong psychological outlook during treatment.

"People facing life-threatening diagnoses often feel alone, and newly diagnosed lung cancer patients with early stage disease can have concerns about an uncertain future, the potential for treatment failure, the cancer spreading and the possibility of death," she said. "Health care providers, who are uncomfortable with and avoid discussing end-of-life questions, may contribute to a patient's alienation.

"Nurses who are comfortable with listening for and discussing existentially related concerns may be in a better position to promote the patient's psychological adaptation."

Too often, health care providers are solely focused on treatment and disease management, Lehto said. Her research identifies the types of death-related concerns that people experience and strategies to help resolve the normal but often distressing psychological responses in the early post-diagnostic and treatment period.

"With a nurse's help, if a patient can resolve the issues that impact quality of life during early treatment, it may greatly improve their outlook," she said. "It is difficult for patients to focus on learning about anti-cancer treatment if they are overwhelmed with anxiety and distressing thoughts."

Lehto said the biggest hurdle to overcome often is helping patients come to grips with the impact of the disease - and the possibility of death - on loved ones.

"Nurses first of all need to be a supportive, nonjudgmental presence," she said. "Patients are making life decisions and sometimes are making death preparations. Nurses can provide patient education materials and offer support in managing life affairs."

Other strategies include exploring life stories, discussing personal relationships and spiritual resources and helping patients locate resources to make funeral arrangements, update wills and other legal issues. Nurses can listen for patient concerns and focus only on personally relevant information so as not to further overwhelm them.

Lehto said the nurse role is essential despite concern that such discussions will increase psychological distress for patients.

"By addressing death-related concerns early, nurses will determine individualized needs for mental health or other supportive interventions or services," she said.

Resume Tips for Nurses

The US Department of Labor projects much faster-than-average job growth for nurses through 2018. That means as employers seek to recruit and retain talented nursing staff, nurses will enjoy improved salaries, benefits and working conditions.

You might be thinking: "Oh good, since employers will be clamoring to hire me, I don't have to worry about my resume."

Wrong.

A winning resume will you get noticed for the best positions and can facilitate a promotion from your current position. A strong resume can also help you command and negotiate a higher salary. Always put your best foot forward on your resume to attract the most desirable job offers. Follow these tips to make your nursing resume shine for an entry-level nurse.

Present Your Value Proposition in a Qualifications Summary

Lead your resume with a qualifications summary that provides an overview of the value you bring to the table. Paint a picture of what you have to offer by including a narrative statement of your goal, specialty area, level of experience and any other top credentials. Use the Career Objective field to present your summary.

Add an Expertise Section

A bulleted list of your proficiency areas incorporates important keywords into your resume (so you're found in an electronic search) and gives hiring managers a snapshot of your capabilities. Your expertise (or Key Skills if you're an entry-level candidate and haven't yet developed expertise) could be nursing specialty areas (e.g., pediatrics, obstetrics) or skills (JCAHO standards/compliance, medication administration, case management). On your Monster resume, use the Skills section to present your areas of expertise.

Detail Your Nursing Experience

Hiring managers want to understand the scope of your experience so they can see if you're a good match for the job opening. When describing your nursing experience, write about the type of facility (such as acute care, outpatient, rehabilitation), your caseload and area of specialization. Entry-level nurses with limited work experience should provide details of their unpaid work/clinical rotations/practicums.

Demonstrate You're a Top Performer

Your experience will be stronger if you include your contributions to each of your employers. Think about how you went above and beyond your job duties to make a positive contribution to your employer, patients, families and the community. Did you serve on any boards or committees? Did you help reorganize or launch new facilities or services? Did you provide training for patients and their families? Did you promote health and well-being by providing free community healthcare seminars? Were you known for your strong patient-advocacy skills? Did you help your employer pass an audit or achieve accreditation? Did you train and orient new employees? By providing details about your accomplishments, you're showing potential employers that you would be a valuable asset to their team.

Focus on Your Related Experience If You're Returning to Nursing

If you are returning to nursing after an absence, target your resume to nursing while deemphasizing unrelated work. One way to handle this dilemma is to divide your experience into two sections. Call the first Nursing Experience and the second Additional Work Experience. This strategy allows you to bring your older, related work to the forefront of your resume. Use the regular Work Experience section for your nursing experience and the Additional Information section to briefly mention your other positions.

Pick the Right Format If You're Changing Careers

If you're a career changer and your previous experience is completely unrelated to nursing, you might require a functional resume format. This style allows you to emphasize your related skills and training, while downplaying your work history.

Highlight Academic Achievements and Nursing Licenses

In your Education section, mention any academic honors, scholarships and fellowships. New grads should consider including their GPA (if impressive) and related courses. Experienced nurses may decide to briefly mention their clinical rotations in the Education section. Licensure fits nicely in the Education section -- include the state where you are licensed and the date achieved. For privacy reasons, avoid including the actual number, employers will ask for a copy of your license later in the hiring process.

Tips for Boosting Supply Chain Efficiency

No matter what supply chain strategies are chosen to increase efficiencies, it's important for hospital supply chain managers and executives to consider the following tips for success:

1. Integrate supply chain management with overall hospital operations and encourage all clinical and non-clinical staff to learn and understand specific goals and work toward them to improve overall patient care.

2. Enlist physician support of supply chain management and engage in regular dialogue to ensure that business and clinical needs are consistently met.

3. Set goals and deadlines for tackling supply chain inefficiencies and track progress made toward overcoming them to hold yourself and your hospital accountable for the process.

15 Florence Nightingale Facts Every Nurse Should Know (Part 3)

 Most students, in nursing school or otherwise, have heard of the famous Florence Nightingale. Yet many may not know some of the most interesting and amazing facts about her life that make her such an inspiration to those in the nursing profession around the world. In honor of National Nurse Week, take some time to read through these facts about one of the most famous pioneers in the field. You might just get inspired to lead your own health care revolution

11. In 1883, Queen Victoria awarded Florence Nightingale with the Royal Red Cross and in 1907 she became the first woman to be awarded the Order of Merit. She is still a highly honored figure in England and around the world, with numerous awards and colleges named after her.

12. Nightingale's book Notes on Nursing is still a classic read for nursing students today. It may not be up-to-date, but the fundamentals it lays out for patient care, cleanliness and treatment can be applied to modern health care settings as well.

13. In the 1870s, Nightingale mentored Linda Richards, "America's first trained nurse." When she returned to the US with her newly acquired training, Richards was able to establish high-quality nursing schools, spreading information, training and expertise throughout the US and Japan.

14. Nightingale was offered a place of burial in Westminster Abbey. This honor isn't handed out lightly and is usually reserved for royals, cultural elites and religious figures. Yet Nightingale's family chose a more humble burial for her, one that she would surely have appreciated, in the graveyard at St. Margaret Church in East Wellow, Hampshire.

15. Her early writings are considered major texts in English Feminism. While not published until after her death, essays like Nightingale's "Cassandra" showcase her feelings about a woman's role in the world quite clearly. Nightingale believed that women were often unnecessarily deemed as helpless when they were quite capable and chided women like her sister and mother who chose a life of leisure despite being highly educated.

15 Florence Nightingale Facts Every Nurse Should Know (Part 2)

Most students, in nursing school or otherwise, have heard of the famous Florence Nightingale. Yet many may not know some of the most interesting and amazing facts about her life that make her such an inspiration to those in the nursing profession around the world. In honor of National Nurse Week, take some time to read through these facts about one of the most famous pioneers in the field. You might just get inspired to lead your own health care revolution

6. Nightingale's own aunt worked under her during the Crimean War. Helping her tend to the wounded, along with 37 other women, her Aunt Mai Smith was by her side to work in the Ottoman Empire in the fall of 1854.

7. At the beginning of the war, Nightingale believed high death rates in military hospitals were due to poor nutrition, lack of supplies and overworking of the soldiers. It was not until after she returned to Britain and was reviewing her work that she came to believe that most of the soldiers at the hospital were killed by poor living conditions. This understanding would change not only how she operated, but how nursing as a profession would be carried out.

8. Nightingale was a proponent of medical tourism. Today, many individuals travel to foreign lands to get medical treatment that doesn't cost the astronomical sums that it does in America. It was no different in Nightingale's time and she was known to advise patients on smaller incomes to travel to places like Turkey, where they could have access to spas, medical treatment and good nutrition at a much lower cost.

9. During her time in the war, she contracted Crimean Fever. She nearly died herself while trying to nurse the wounded men back to health, contracting a form of typhus, a disease from which many of her coworkers and patients would die. While she recovered from her illness, it would cause medical issues that would confine her to bed rest for much of her later life.

10. Florence had a great love of mathematics and devoted much time in her later life to using statistics to better understand health care. She is credited with starting a health revolution in India, collecting data from military outposts through the mail and creating a detailed report based on the stats she was able to compile. Her findings helped push forth changes that would reduce the high death rates of soldiers and would improve health care and sanitation for everyday people as well.

15 Florence Nightingale Facts Every Nurse Should Know (Part 1)

Most students, in nursing school or otherwise, have heard of the famous Florence Nightingale. Yet many may not know some of the most interesting and amazing facts about her life that make her such an inspiration to those in the nursing profession around the world. In honor of National Nurse Week, take some time to read through these facts about one of the most famous pioneers in the field. You might just get inspired to lead your own health care revolution

1. Born into a wealthy, upper class family in the early 19th century, Nightingale was never expected to pursue her own career. Her family wanted her to get married and have children, not work in a hospital. Yet she rejected marriage proposals, fearing that they would get in the way of her work, and pushed on with her career in spite of it being a great point of contention with her family.

2. She got her name "Lady with the Lamp" from the lamp she carried with her as she checked on patients in the battlefield hospital during the Crimean War. She had a habit of checking on patients in the middle of the night while carrying a simple oil lamp, a romantic image of nursing that survives to this day in her legacy.

3. She would play an instrumental role in setting up proper military hospitals in the United States during the American Civil War. Her experience in the Crimean War, along with her reputation for revolutionizing nursing care, made her an ideal choice to advise how the army should set up hospitals in the U.S. While she faced some initial opposition, her ideas were generally adapted.

4. Nightingale founded the first secular nursing school in the world at St. Thomas' Hospital in London. It is still there today, training nurses for work as RNs and midwives and happens to be the number one nursing school in London.

5. She traveled extensively, studying hospitals in places like Greece, Egypt and Germany– journeys which would be the inspiration for her career in nursing. It was during her time in Egypt that Nightingale wrote of feeling "called to God" to a career in nursing and when she returned to Europe, stopping in Germany she spent four months training at The Institution of Kaiserswerth on the Rhine. When she returned home, she was ready to begin her nursing career in earnest.

A Closing Word: 10 Tips for Getting the Most From a Professional Conference ( Part 2)

6. Comfort is important: Rooms at hotels and convention centers are usually kept cold to accommodate the sudden shift of hundreds (or even thousands) of people in a brief time. Bring a sweater with you so that if you are chilly, you can warm up. In addition, pack some snacks in your bag so that if you miss a meal or do not like the food that is served, then you can make it until dinner.

7. Take care of those who take care of you: When you travel, there are many people who make your life a lot easier, so be sure to tip them when the service is good. This applies to bellmen that help you with your bags, shuttle and taxi drivers, and maids. Take several small bills with you before you leave home so you will have them available. The art of tipping is beyond the scope of this article, but several online resources are available that discuss the usual amounts of tips.

8. Be respectful to your colleagues and to the speakers: Most speakers are genuinely excited to be presenting their ideas to a group. Some speakers are relatively inexperienced, whereas others speak routinely. Cell phones and side conversations make it difficult for others to hear and for the speaker to concentrate. In my opinion, it is rude to the speaker to get up and leave in the middle of the presentation. If you think you might need to leave early, then sit at the back of the room and leave quietly. Again, review the handouts ahead of time if possible to know what the session is about.

9. Stay organized during the conference: It is easy to get into "information overload" during a conference. Sometimes, we come away with lots of notes, ideas, and enthusiasm only to find them sitting in the conference bag 3 months later. Try to keep a pad of paper with you all the time and organize the pages into categories like "resources to obtain," "things to follow up on," "people to contact," and so on. Add items to each of these pages throughout the conference. When you return, these pages remind you of what you want to do with the information you gathered at the conference.

10. Spread the enthusiasm and share what you learned: When you return home, tell your fellow staff about the conference. Share pictures that you took. Consider giving a brief presentation at a staff meeting about a new idea or treatment strategy you learned about. The enthusiasm that you had in the moment can continue if you talk about it.

A Closing Word: 10 Tips for Getting the Most From a Professional Conference ( Part 1)

Springtime is conference season! Many professional organizations hold their annual conferences during the coming months. Attending conference provides all with current practice information, new ideas, and networking opportunities with colleagues. However, the vast amount of information presented at conferences can be overwhelming. Thus the following tips will be helpful to get the most out of a conference:

1. Choose your sessions strategically: If you have not already done so during registration, review the presentations offered during each time slot. Conferences are some of the best places to learn about new approaches and therapies. Sometimes, you can choose a session based on the reputation of a speaker, as outstanding speakers and teachers can help explain difficult concepts clearly. If you have access to the handouts or presentation outline, it can be helpful to review these ahead of time. Sometimes, presentation titles are catchy but might not capture the essence of the presentation. If there are multiple sessions you want to attend during the same time, there are a few options. See if the session is repeated at other times during the conference. In addition, if a colleague is attending the conference, then you can each attend 1 session and compare notes. Otherwise, see if the conference is recording the sessions and purchase a recording.

2. Networking is key: One of the biggest benefits to conferences is the opportunity to meet other professionals. Remember, these are people who have similar interests to you, so you already have a lot in common. Besides meals, there are times to talk during breaks, between sessions, and in the evening. It can be difficult for some people to talk with people they do not know very well, so remember to ask others where they work, how they handle certain processes or diagnoses, and what some of their memorable experiences have been. If you ask, most people will share information with you. For example, if your unit is struggling to implement a ventilator-associated pneumonia (VAP) bundle, and then ask people you meet if they have implemented a VAP bundle. Their successes and challenges might give you some good ideas about how to deal with your own struggles. Be sure to bring business cards to trade so that you can stay in touch with people you meet. If you do not have hospital-based business cards, consider having some made via an online service with your name, credentials, and contact information. These cards are inexpensive and go a long way toward projecting a professional image.

3. Dress the part: At a professional conference, we should look professional. Sometimes, the conference materials will suggest the proper attire, which is often business casual. Remember that you will be meeting new people and making a lot of first impressions. Nursing is a relatively small world, and you never know if that person you meet today will be a colleague tomorrow.

4. Attend the poster presentations: If the conference offers poster presentations, be sure to make some time to attend these. Posters are often where the innovative ideas and initial research are presented. You will likely get a chance to meet the poster presenters and ask them details about their projects.

5. Attend the exhibits: Vendors, such as pharmaceutical companies, medical device companies, publishers, and hospital recruiters, often pay the conference to set up exhibit booths. The size of these exhibits varies depending on the conference. This information can be helpful to hospital administrators when making product selections. In addition, many of the vendors provide token gifts to encourage you to stop and talk to them. Usually take these when offered, but it is not uncommon to see people taking handfuls of pens and pads of paper. Be respectful of others so that there is enough to go around to all the participants. Brochures and other things you pick up along the way can take up a lot of space and add significant weight to your suitcase. Be sure to leave room for these things when packing at home and be aware of the weight limits on suitcases.

The Importance for a Healthcare CFO to Have a 360 Degree Outlook

Healthcare organization Chief Financial Officers (CFOs) should not take their eye off the ball. Every time there is a change from the federal or state government, they have to look at it from a 360 degree perspective, as making a decision in a vacuum could lead to costly consequences.

What would be the strategies for increasing efficiency of healthcare CFOs?

 It is important that healthcare CFOs have elements in place to be able to put their finger on what their costs are. They can no longer wait until the end of the month to determine their labor costs, as that will be too late. They need to maintain them on a day-to-day or weekly basis to effectively manage and correlate their labor efforts to the volume of activity they have had.

There are mechanisms available which provide time management and productivity through attendance systems, so having these interfaced and correlated with the payroll system is critical.

Many healthcare organizations are looking at processes such as lean six sigma and other practices, which have propelled us into a new world where we have input from all the players across the continuum. These have helped us give the right care and medicine to the right patient at the right time, leading to increased efficiencies, lower costs and better outcomes.

What could be suggested  for maximizing reimbursement?

If you do not have a margin, you cannot continue your mission of meeting the healthcare needs of the sick. Reimbursement is paramount as it goes hand in hand with the total operation of the organization. It is not enough to focus only on being efficient and maintaining costs when most of the money comes from the federal government. Having good clinical documentation and ensuring you get credit for everything you do for the patient is critical for maximizing reimbursement.

What is our outlook for the future and what changes should healthcare CFOs be preparing for?

Healthcare has always been a challenge, whether it has been cost control or decreased reimbursement, but CFOs have always managed in their environment. There are fewer hospitals operating today than in the past, as many providers were not able to justify their existence. The facilities that adjusted have thrived, and are doing better than ever before. The US healthcare system is the best healthcare provider in the world. It is attributed to the challenges we have had to overcome and the hurdles we have had to jump across.

There are ongoing efforts in today’s environment to make sure you get the most for your money. It has been this way for a long time, but now with healthcare reform and the push in the near future for accountable care, organizations might potentially have only one main source of revenue. Making sure the organization is run efficiently will be more important than ever before.

A final message for healthcare organization CFOs

 Be careful to safely guard what has been placed in your hands. As the CFO, you have the responsibility of ensuring financial stability. Do not lose sight of why you are in healthcare, and enjoy what you do every day. Go to work with a smile on your face and accept the challenges for what they are.